Health Care Providers In Emergency Mode

The Elderly And Infirm

Days before the first snowflake fell, the region's home health clinicians pondered not only how they would care for elderly homebound patients during last weekend's historic storm, but if they could reach their doorsteps at all.

They began extensive emergency planning, including deploying extra staff and triaging patients. And with another snowfall expected later today, agencies are rushing to get patients back to their regular home visit schedules and stocking them with necessary supplies.

"This is unprecedented," said Keith Ballenger, vice president of Adventist Home Health, which cares for more than 6,000 patients a year in seven Maryland counties. "I've been here 22 years, and I've never seen a back-to-back storm occur this close together. It's really taxing on us."

Before last weekend's blizzard, the agency organized patients by need. Clinicians tried to see as many patients they could Friday before the snow began falling. They called patients whom they wouldn't be able to visit on Saturday to make sure they had supplies such as oxygen tanks with backup batteries, wound dressings and the number to the 24-hour nurse on call.

On Sunday and Monday, nurses began trudging through unplowed streets to see patients.

"We have a lot of staff working today. Some are parking their cars and walking a quarter of a mile to get to patients," Ballenger said. "They're out there with their shovels and their boots and their survival kits knowing they need to do what they need to do."

The needs of patients vary from those just released from the hospital to the chronically ill who have nurses care for them 8 hours a day. "Most people don't realize until they are in that situation, we are a lot like a hospital in a home," he said. "We have very sick patients."

For patients in their last months of life, clinicians often plan for a sudden deterioration in their conditions. But a vicious snowstorm makes that planning vital, said Regina Bodnar, director of clinical services for Gilchrist Hospice Care, which cares for 450 patients.

Over the weekend, a handful of home hospice patients lost power and had to be transferred to Gilchrist's Towson outpatient center. But there were no other big problems, Bodnar said. Clinicians made sure patients had supplies and pain medication before the storm. They did not visit patients on Saturday, but a handful went out Sunday and more on Monday, she said. Over the weekend, staff touched base with patients' families.

"When you have a loved one who is on hospice care, there are so many different issues to deal with," Bodnar said. "If we can keep as much of the snags and hiccups to a minimum in caring for Mom and Dad, then we've done a really good job. We just have to work a bit harder to do that when there's 30 inches of snow on the ground."

With more snow on the way, Bodnar is working with pharmacies to make more frequent medication orders for patients. Typically, the hospice staff may make pharmacy orders every eight days, but they have asked pharmacies to change that rule to every five days.

Organizing the logistics for a home health operation is a big undertaking, said Traci Anderson-Araujo, president of MedStar Health's visiting nurses association.

"Not only do I have the safety and care of 1,500 patients on my mind, but I have to think of the safety and care of my 300 clinicians and all the people it takes to do this in my organization," she said. "Thankfully, we had zero incidents, but it was really pretty treacherous out there."

The Baltimore health department spent last Friday fine-tuning emergency plans to shuttle dialysis patients between their homes and treatment centers over the weekend. The department covers transportation for patients on medical assistance, as required by federal law. The safety-net program also offers transportation to patients who need chemotherapy and radiation. But among the most logistically challenging for the department are patients who need three-times-a-week dialysis, said Pamela Somers, program director of field health services for the health department.

The threat of a blizzard means trying to reschedule some patients, while arranging a fleet of vans to go out on snow-covered roads to transport patients who cannot change their schedule.

"It's also a huge challenge for patients," said Somers. "For folks whose times are being shifted, they need to change their diet a bit and watch their fluids. There are medications that we can give them to have them hold out an extra day."